New Connect Service Application | Comanche Electric Cooperative

Primary Account Holder Information

First

Middle

Last

Business Name

What is the name of your business? If this is a residential meter, please type 'N/A'.

Address

City/Town

State/Province

ZIP/Postal Code

DOB

Contact Number

Best number to reach you regarding outage situations

Cell Phone

Employer

Work Number

Spouse Information

First

Middle

Last

DOB

Contact Number

Spouse e-mail

Information on Account Can Be Released to (family, friends, attorney, etc.):

First

Last

First

Last

First

Last

Connecting Information

Meter Number(s) or Pole Number(s) to be connected

Preferred Connect Date

What will meter serve?

Gate Combination

Do you own or lease?

Own

Lease

Is light to be connected?

Yes

If more than one light, how many and which ones?

Alerts and Reminders

Would you like to receive billing alerts?

Which of the following alerts would you like to receive?

Due Date Reminder

Past Due Date Reminder

Returned Check Alert

Payment Confirmation

Outage Alerts

Would you like to receive notifications by email or text?

Additional Information

Would you like standard or e-billing?

What day would you like your bill to be due?

Would you like to put your account on a credit card or bank draft?

Do you or any member of your family depend on life support systems?

Would you like to participate in Operation Round-Up?

As a participant, your electric bill is rounded up to the nearest dollar each month and the few extra cents go into the Operation Round-Up community service program fund.

Signature and Authorization

I agree for CECA to perform a credit check to determine the applicability of a security deposit.

If you selected "yes," a CECA representative will reach out to request your Social Security number and driver's license number.

Please type your First and Last Name

Terms of Acceptance and Signature

The information contained in this application is for the purpose of obtaining electric service from Comanche Electric Cooperative on behalf of the abovesigned. The abovesigned acknowledges that the information provided herein is true and complete. I, the applicant for this CECA connect request, warrant the truthfulness of the information provided in this application.

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